SAN DIEGO — No one wants to hear the words: "You have cancer." . . . As I understand this case, it's a wrongful death suit, so therefore, I will not be present at the time (it) is heard.
--Videotape deposition of breast cancer victim Marcine Cohen, Jan. 13, 1983. Died: June 18, 1984.
There is a deceptively home-movie flavor to the picture on the television screen. The camera zooms to a tight close-up of a smiling young woman named Marcine Cohen, who is talking sensitively and, at times, matter-of-factly about her plans for herself, her children and her marriage.
"I would hope I will be my image of what an adequate mother would be," the young woman says, "which is supportive and protective and there to guide them through difficult decisions . . . and mostly to nurture."
But it was not to be. The television picture disguises the fact that Marcine Cohen was wearing a wig--necessary because chemotherapy had robbed her of her natural hair. A breast cancer victim who had already undergone two mastectomies, she would be dead in less than 18 months.
She would die shortly after receiving her doctorate in sociology from UC San Diego--at a ceremony to which she was taken in a wheelchair, wearing an oxygen mask, because she told her husband she refused to be accorded her Ph.D. while lying in bed. Her death, on the date of her 17th wedding anniversary, would follow by two days the bat mitzvah of Davora, the firstborn of her two daughters. Surviving to the ceremony had virtually consumed Marcine Cohen for the last few months of her life, her husband recalls.
'She Was a Fighter'
"The quality of her life had not been good," her husband said. "It's hard to tell you what my wife was like, but she was a fighter. She just literally gave up at that point (the bat mitzvah). That's the way I interpret it.
"I didn't believe in the will to live, but this sure as hell changed my point of view on that subject."
And she would go to her grave at age 38 bitter and angry with the U.S. Navy because, she says to the television camera--and her family has contended in a malpractice suit asking $5.5 million because of her allegedly wrongful death--she believes a Navy surgeon, Dr. William MacLeod, failed to follow fundamental medical logic, leading to a seven-month delay in her diagnosis.
By the time the San Diego Naval Hospital finally realized it was cancer, said the civilian specialist who eventually took over the case and treated her until she died, Marcine Cohen's fate was probably sealed--though it is possible she would have become terminal even if the diagnostic error had not been made. But a mistake it was, says Dr. Mark Green, the UC San Diego civilian oncologist--one that would have been just as avoidable in 1977, when the Navy doctor missed the first opportunity to diagnose the cancer, as it would be today.
Of itself, the case is representative of several pending or settled in the last three years against Southern California Navy hospitals, where military physicians have apparently had significant problems with cancer diagnosis, the general field of women's health or both. Marcine Cohen's death is unusual in several respects, however. To begin with, her husband was a Navy doctor, assigned to the same naval hospital.
Dr. Irving Cohen, 39, went to medical school on a Navy scholarship he won after returning from service as an Army infantry lieutenant in some of the hottest spots of the Vietnam War.
Marcine Cohen went to MacLeod when she noticed a lump in her right breast that remained unchanged through three menstrual cycles. A diligent practitioner of self-examination, she was one of many women whose breasts often develop small,
This one, though, was different. Her husband, still in his residency, was honing his skills in kidney disease. He recognized he was not technically qualified to evaluate the case nor emotionally fit to deal with something so close to home. He said he got his wife an appointment with MacLeod, then a Navy captain and chief of the hospital's general surgery department.
Medical records show MacLeod passed a needle into the lump and noticed that no liquid escaped from it. He concluded it must be a benign cyst. And that, other doctors say, was his mistake. He should have known that if a lump is a cyst, physicians who have reviewed the case say, it will produce fluid in the biopsy needle. Failure to find fluid means the next step--a full biopsy--must be taken since there is a significantly increased chance the lump is a cancer. The biopsy remained undone--for seven more months.
Left the Navy
Sometime after Cohen died, MacLeod left the Navy. He now works as a surgeon and general practitioner in Alamosa, Colo. Reached by telephone, he declined to discuss his handling of the Cohen case. "I don't want to talk about it in any way," he said.